This research continuation into adolescence proposal is a request to follow a unique sample of children born at various degrees of prematurity and late medical risk. We have been following 192 families whose children were born at medical risk, from birth to age 12, with continual funding from NINR. This proposal incorporates the research directions established by the National Institute of Nursing Research's initiative and Healthy People 2010 to develop practice knowledge in health promotion for older children and adolescents. The proposed project is an innovative and unique effort to examine both the transition from early to late adolescence as well as the entire continuation of childhood in a sample of children born at various degrees of medical risk. Results from our research to date inclusive from birth to age 12, provide a comprehensive understanding of specific developmental trajectories and risk and protective processes that exacerbate or ameliorate the impact of cumulative risk on competency outcomes in full term and preterm children. The Specific Aims: (1) Investigate and model developmental trajectories from birth to age 18, in the sample of children born at various degrees of perinatal morbidity. The trajectories of growth, medical, neurological, motor and problem behavior. (2) Examine the models by which cumulative medical and environmental risk, from birth to age 12, have an independent effect on developmental competency constructs of health, academic, social and functional performance at last adolescence. (3) Examine how cumulative protective processes, from age 4 to 18, will have an independent effect and/or mediating effect on cumulative risk, on developmental competency constructs of health, academic, social, and functional performance at late adolescence. Compelling findings from our work support the need for trajectory follow up. For example, physical attainment at adolescence shows some "catch up" growth, yet preterm, especially SGA children, remain smaller and lighter than their peers at age 12. The rate of overweight and obesity rates were three to four times the national average in the preterm group ranging from 32% to 41%. In the motor trajectory, the incidence of motor deficits doubled from 11% at age 8 to 21% at age 12. Our most striking finding has been the importance of cumulative risk and cumulative protective processes heretofore undocumented, in the prediction of competency of early adolescence. Repeated measures using mixed effects models will be used to determine developmental trajectories and test the effects of risk and protection in determining health, academic functioning, and social competency outcomes at age 18. Late adolescence will be an important and necessary addition in developing a total model of development that incorporates both time-specific and cumulative risks as well as protective processes for an entire period of childhood. Such studies are urgently needed to build a broader scientific foundation for nursing interventions. This proposal is very specific in identifying connections between the literature, our prior studies, the need for trajectory follow through, and risk and protection in the understanding child competency outcomes. Based on the cutting edge work of our collaborators in risk contexts, we will develop models where cumulative risk and protective processes are highlighted.